ABSTRACT
Aims and Background: To prolong postoperative analgesia many adjuvants has been used opioids and alpha-2 agonists are very popular among them. This study was aimed at comparing the sensory, motor, hemodynamic, sedative and analgesic properties of epidural administration of fentanyl and dexmedetomidine as an adjuvant to ropivacaine
Methodology: With Institutional ethical committee clearance this study was conducted at our hospital. After obtaining informed and written consent, a total of 60 patients scheduled for elective percutaneous nephrolithotomy [PCNL] were randomly allocated into two groups of 30 each. Patients of both genders, aged 21-60 y, ASA physical status I and II were enrolled. Group RD received 28 ml of inj ropivacaine 0.5% + dexmedetomidine 1 ng/kg and Group RF received 28 ml of ropivacaine 0.5% + inj fentanyl 1 pig/kg epidurally. Hemodynamic parameters, sedation scores, and time to onset of sensory loss, complete motor blockade, two segmental dermatomal regression and time of first rescue analgesic were recorded. Data were compiled systematically and analyzed using unpaired t-test, Chi-square and Mann-Whitney U test. P < 0.05 was considered significant
Results: The demographic profile of patients was comparable in both groups. Onset of sensory analgesia up to T10 was 6.8 +/- 2.8 min vs. 8.7 +/- 2.7 min and time to reach maximum motor block was 19.8 +/- 5.8 min vs. 23.9 +/- 4.9 min in Group RD and Group RF respectively, which was significantly less in the Group RD. Postoperative analgesia was significantly prolonged in the Group RF as compared to Group RD, e.g. 394.5 +/- 36.5 vs. 268.5 +/- 28.3 min respectively. Sedation scores were better in the Group RD and highly significant on statistical comparison [P < 0.001]. Incidence of hypotension, nausea and vomiting was high in the Group RF, while incidence of dry mouth was higher in the Group RD
Conclusion: Dexmedetomidine is a better adjuvant than fentanyl when added to epidural ropivacaine in terms of early onset of sensory and motor block, prolonged postoperative analgesia and better sedation with less side effects